DESCRIPTION: This is a revised application to identify and study a large cohort of glucocorticoid remediable aldosteronism (GRA) patients. The spectrum of the severity and the natural history of the disorder will be characterized. The proposal seeks to determine modifying environmental and genetic factors which are important in regulation of blood pressure. Also, renal physiology will be studied in GRA patients to determine how these patients escape hypokalemia in spite of mineralocorticoid excess. There are four specific aims: 1) to determine the natural history and prevalence of GRA in various hypertensive populations, 2) to characterize the magnitude of effect imparted on blood pressure by inheritance of GRA and the sources of variation in phenotype expression of the hypertension, 3) to investigate the renal and hormonal mechanisms regulating potassium conservation and loss in GRA, and 4) to characterize the disequilibrium of GRA with Irish and Scottish descent and specific alleles of the aldosterone synthase gene.